Images in Cardiothoracic Medicine and Surgery
Anomalous drainage of a persistent left superior vena cava into the left atrium
Asian Cardiovascular & Thoracic Annals 2014, Vol. 22(9) 1122 ß The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492313504577 aan.sagepub.com
Figure 1. (a) Chest radiograph showing the central line in the middle of the left chest. (b). Computed tomography venogram showing the central line going through the persistent left superior vena cava into the left superior pulmonary vein, with the tip draining blood from the inferior part of the lingular vein.
A 56-year-old lady, with normal oxygen saturation and no features of cyanosis, had a life-threatening anaphylaxis reaction on anesthetic induction just before kidney transplantation for end-stage renal failure. A left internal jugular central line was urgently inserted, and chest radiography showed the line to be in the middle of the left chest (Figure 1a). A dumped pulsatile waveform was detected, and on repeated gas analysis, the pO2 was above 400 mm Hg, suggesting catheter location in a pulmonary vein. The possibility of line extravasation and left lung perforation was considered. A computed tomography venogram showed a persistent left superior vena cava draining into the left atrium through the left superior pulmonary vein. The left internal jugular central catheter went from the persistent left superior vena cava into the left superior pulmonary vein, with the tip draining blood from the inferior part of the lingular
vein (Figure 1b). The line was safely removed and the patient recovered well. Persistent left superior vena cava is an anomaly of the 8th gestational week and occurs in 0.3%–2% of the general population; it usually drains into the right atrium via the coronary sinus and very rarely into the left atrium directly or via and unroofed coronary sinus or the left superior pulmonary vein. Funding This research received no speciﬁc grant from any funding agency in the public, commerical, or not-for-proﬁt sectors.
Conflict of interest statement None declared.
Department of Cardiothoracic Newcastle, Australia
Corresponding author: Fabio Ramponi, FEBVS, Department of Cardiothoracic Surgery, Level F3 John Hunter Hospital, Lookout Road, New Lambton, NSW 2305 Australia. Email: [email protected]
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